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Community Acquired MRSA: That ain't no spider bite!

December 7, 2016

“The itsy bitsy spider crawled up the waterspout; down came the rain
and washed the spider out.”

Recently, a colleague of mine and I were discussing all the crazy things
we have seen in our years of practice, recounting the infamous precursor
to most trauma incidents: “Hey guys, watch this!” After we
both ran the gamut of one-upping each other, there was a pause in the
conversation, and he asked, “So how many spider bites have you seen?”
I thought for a moment, mentally searching my files and came up with a
startling number . . . “ONE!” He nodded and said, “Me
too.”

Although a true spider bite is as rare as hen’s teeth in my practice,
I have seen its doppelganger again and again: community acquired MRSA.
This common but serious condition—medically diagnosed as community
associated methicillin-resistant Staphylococcus aureus but called CA-MRSA
(or just MRSA) in the lay community—is on the rise in athletes and
causing concerns in primary care and sports medicine physicians. MRSA
is usually a mild superficial skin infection that may cause folliculitis,
small abscesses, cellulitis, carbuncles and tissue destruction. They typically
develop spontaneously and are so frequently mistaken for and diagnosed
as spider bites that they often go untreated until they become dangerous.
At its onset, MRSA is very hard to differentiate from common minor bites
and abrasions, especially in children. Not until they take on a red ring
indicating infection (called cellulitis) do people begin to realize the
“spider bite” may not actually be what it seems.

The rub with MRSA is that it’s a resistant bacterium that does not
respond to local wound care or first line antibiotics. Because it isn’t
self-limiting, it can result in further complications in the patient,
including bony involvement, lung and liver involvement, and sepsis. Also,
athletes commonly and unknowingly pass MRSA to teammates through direct
skin exposure, by borrowing personal items and even by training on the
same equipment. For this reason, athletes, daycare and school students,
and military personnel are at a higher risk of infection than the general public.

Most Staph infections, including MRSA, appear as a bump or infected area
that may be:

Red

Swollen

Warm to the touch

Painful

Draining

Accompanied by fever

If you experience these signs or symptoms, the lesion should be covered
with a bandage and you should promptly have it assessed by a doctor. It
is especially important to contact a doctor if the possible MRSA infection
is accompanied by a fever.

Prevention is the best treatment of MRSA. These infections can reach epidemic
proportions in a locker room and can be extremely hard to eradicate. In
general, every athlete should keep any wounds covered to prevent its spread
to others, but should you suspect you have MRSA, draw a circle around
the suspicious spot and watch to see if the swelling or redness extends
outside the circle over the next couple days. If it does, you should seek
medical attention.

Other recommendations include:

Wash hands frequently.

Disinfect non-clothing surfaces with bleach.

Athletes should shower immediately after participation in training.

Athletes should not share personal hygiene items.

Wash towels and uniforms in hot water after use and dry completely in a dryer.

The first question every infected athlete asks is, “When can I return
to play, doc?” The answer to this question depends on the extent
of the infection and how easily others can be insulated from transmission.
The National Collegiate Athletic Association (NCAA) guidelines for a MRSA
infection state that players can return to play after they have been on
appropriate antibiotics for 72 hours and experience two days without a
new lesion. Even during the treatment process, the wound should be kept
securely bandaged and frequently checked by the trainer to ensure the
wound isn’t exposed during athletic participation. Athletes are
not the only people who can become infected with MRSA, of course, but
the same protocol should be followed for anyone who is diagnosed.

Different sources can cause skin lesions and result in MRSA. Most cases
of MRSA can be sufficiently treated by localized wound care, good hygiene
and vigilance. “Prevention is worth a pound of cure” is a
good adage to follow here. Be proactive about your own body, and watch
any lesions you may develop carefully. See something suspicious? It’s
probably not a spider bite . . .